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A study published in the July issue of Pediatrics suggests that babies born at what is considered full term, but at 37-38 weeks, have lower academic achievement in third grade than those born at 39-41 weeks gestation. They found this effect to be independent of birthweight or other social or economic risk factors. Authors examined birth records from a large inner city hospital, and then looked at achievement test scores of these children in third grade. They write:

For example, children born at 37 weeks’ gestation were found to be 33% more likely to experience a severe reading deficit (defined here as 2 SDs below the mean) relative to children born at 41 weeks’ gestation.

I suggest that the issue be framed not as "are these babies at risk?" but rather "are these early relationships at risk?" When a baby is born at 37 or 38 weeks, parents are discharged home with the message conveyed that the baby is "normal." But these babies may be more difficult to feed, may not transition as easily from awake to asleep, or may have more difficulty settling. In a supportive, relatively unstressed environment, these differences may be hardly noticeable. But in a stressed environment, including such things as single parenthood, postpartum depression or any number of social stressors, it may be more difficult for a parent to help a baby manage these biological vulnerabilities. As parents get overwhelmed by feelings of inadequacy, there may be a rapid downward spiral of increased fussiness and feeding problems, sleep deprivation and parental depression. It is likely that the stressed relationship, not simply the gestational age, is linked to later academic achievement.

As I have written about in previous posts, the Newborn Behavioral Observation system offers a wonderful tool to support potentially at-risk mother-baby, and father-baby, pairs. It offers a way to help parents to recognize their baby's unique behavioral characteristics and ways of communicating. It can be performed in as few as 20 minutes in the hospital setting. Ideally such an intervention would be available to all parent-baby pairs. At the very least, when babies are born at 37-38 weeks, these parent-baby pairs deserve a bit of extra time. Clinicians can assess if these types of problems of self-regulation are present, and if they are, support parents efforts to help their babies manage these vulnerabilities.

Certainly more research is needed, as the authors, suggest, to elucidate the mechanisms underlying the association between gestational age and academic achievement. In addition, exercising care with regard to elective deliveries before 40 weeks is important. But in my opinion, this study points to the need invest resources to support newborn-parent relationships. We know that the newborn period is a time of rapid brain development, and that the brain develops in relationship with the primary caregiver. That the newborn period may be linked to what happens at age eight should come as no surprise.